Healthcare Provider Details

I. General information

NPI: 1295234938
Provider Name (Legal Business Name): LASHANDA GABRIELLE PUTMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 ALABAMA HWY
RINGGOLD GA
30736-2804
US

IV. Provider business mailing address

30 BURTON HILLS BLVD STE 175
NASHVILLE TN
37215-6403
US

V. Phone/Fax

Practice location:
  • Phone: 706-935-6442
  • Fax:
Mailing address:
  • Phone: 615-988-2014
  • Fax: 615-208-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN227459
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: